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Patient > Drugs in the management of Glaucoma > Flashcards

Drugs in the management of Glaucoma Flashcards

1
Q

_____ is the precursor for all sex hormones

A

cholesterol

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2
Q

how are androgens converted to oestrogen?

A

via aromatase enzyme

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3
Q

TF: progesterone levels in men are the same as in women

A

true

but not when women have ovulated as levels rise

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4
Q

oestrogen and progesterone are important in ______ in males

A

spermatogenesis

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5
Q

where is sperm produced?

A

testes

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6
Q

what are the 3 accessory glands in the male?

A

prostate
seminal vesicles
bulbourethral glands

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7
Q

what do the 3 accessory glands to do to the ejaculate?

A

secrete fluid into it

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8
Q

what passes through the urethra?

A

both urine and semen

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9
Q

why does both urine and semen pass through the urethra?

A

as the vas deferent feed the urethra below the bladder

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10
Q

what glands secretions line the male tract and make it lubricated for sperm flow

A

Bulbouretheral gland

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11
Q

what fills with blood when a male has an erection?

A

the croups cavernous and the

spongiosum

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12
Q

function of the testis

A

sperm production

steroid hormone production

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13
Q

function of the epididymis

A

sperm collection and maturation

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14
Q

function of the ductus deferens

A

transport and storage

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15
Q

functions of the urethra

A

transport

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16
Q

what part of the testes produces sperm?

A

seminiferous tubules

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17
Q

what happens to the sperm once its produced by the seminiferous tubules?

A

passes through tubes into the efferent ducts and then into the epididymis for maturation

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18
Q

2 cells in the seminiferous tubules?

A

larger and smaller cells

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19
Q

characteristics of the larger cells in the seminiferous tubules?

A

resident epithelial cells of the tubules

provide environment for sperm development- nurse cells

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20
Q

characteristics of the smaller cells in the seminiferous tubules?

A

more concentrated towards the centre of the tubule (with smaller nuclei- characteristic of developing sperm) the spermatozoa are moving from inside the tubule, upwards through the nurse cell environment and concentrate near the top side of the inner surface of the Sertoli cell. Then put into the lumen of the tubule and transported.

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21
Q

seminiferous tubules are surrounded by _____ _____

A

myoid cells

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22
Q

the spaces between the tubules contain _____ cells

A

leydig- interstitial

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23
Q

where are Sertoli cells more concentrated in the tubules

A

near the edge of the circle

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24
Q

what are leydig cells characterised by

A

white dots in the cytoplasm

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25
Q

what are the white dots in the cytoplasm of leydig cells important for?

A

steroid production

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26
Q

first steps of _____ synthesis occur in leydig cells

A

steroid

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27
Q

what do myoid cells do?

A

contract and move the sperm from the lumen as they cant swim yet

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28
Q

biosynthesis of testosterone is mainly in _____ cells

A

leydig

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29
Q

what is testosterone converted into?

A

dihydrotestosterone

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30
Q

what enzyme converts testosterone into dihydrotestosterone?

A

5a- reductase

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31
Q

why is the conversion of testosterone into dihydrotestosterone important?

A

DHT is a more active androgen than testosterone

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32
Q

what does binding of steroidal ligand to cells with receptors on do?

A

produces a complex with the receptor which then acts on DNA

this alters the repertoire of genes being expressed by target cells and alters RNA production

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33
Q

the way the steroids interacts with the DNA defines them as….

A

transcription factors

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34
Q

what are androgens defined as?

A

compounds that interact with the Androgen receptors and effects them- not a particular structure

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35
Q

what cells in the male reproductive system react to androgens? why?

A

ALL

because they all express AR receptors

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36
Q

why is androgen binding needed in all cells?

A

to fulfil their rolls in sperm production, transport and activation
genes need to be activated to trigger processes

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37
Q

where else are androgen receptors found?

A

where secondary sexual characteristics are found- facial hair
male baldness
increased bone density

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38
Q

what are responsible for the development of secondary sexual characteristics?

A

androgens

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39
Q

the ______ control sex steroid production

A

gonadotrophins

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40
Q

explain the HPG axis in males.

A

GnRH in hypothalamus and is - transported to anterior pituitary via a blood vessel (almost the same as in female)
Pituitary produces LH and FSH- govern the production of steroid hormones in the testes

41
Q

pulse ______ of GnRH controls sex hormone production in females

A

frequency

42
Q

in males GnRH is pulsating how?

A

at a fixed rate

43
Q

the fixed rate of pulsation in males means?

A

there’s constant levels of LH and FSH

44
Q

what do the sex hormones do in relation to the sperm?

A

primes cellular environment to help maturation of sperm

45
Q

gonadotrophins need receptors where?

A

at the cell surface

46
Q

TF: polypeptide hormones dont need receptors at the cell surface? why

A

false- they need them

as they’re water soluble macromolecules

47
Q

where are FSH receptors expressed in males?

A

Sertoli cells

48
Q

where are LH receptors expressed in males?

A

leydig cells

49
Q

what cells produce androgen binding protein?

A

Sertoli cells

50
Q

what is the function of androgen binding protein?

A

bind steroids as they aren’t water soluble

released as a complex

51
Q

where does the steroid ABP complex travel from the Sertoli cell?

A

to the accessory glands

52
Q

when ABP binds T and DHT what does it do?

A

concentrates them in the luminal fluid of the seminiferous tubules and downstream regions of the male tract

53
Q

what does the concentration of T and DHT by ABP in the luminal fluid of the seminiferous tubules stimulate?

A

o spermatogenesis in the seminiferous tubules,
sperm maturation in the epididymis
accessory gland secretions
myoid cell contractile activity to propel sperm along the tract

54
Q

gonadotrophins are _______.

A

polypeptides

55
Q

in male feedback from the gonadotrophins are purely ______

A

negative

56
Q

feedback by testosterone is at the level of the…..

A

anterior pituitary and the hypothalamus

57
Q

what in females stimulates positive feedback?

A

oestrogen at a specific time of the cycle

58
Q

how does the spem move in the sinoli lumen?

A

from the outside to the apical/ inner surface of the sinoli lumen

59
Q

in the time the sperm moves from the outside to the inside of the sinoli lumen, what happens?

A

it undergoes 2 divisions

meiosis

60
Q

at what point do spem cells acquire the characteristics of sperm cells?

A

after the second meiosis division

61
Q

the sperm exit _____ first into the lumen

A

tail

62
Q

the maturation of the sperm is ______ dependent

A

androgen

63
Q

sperimogenesis refers to the stages ______ meiosis

A

POST

64
Q

spermatogenesis refers to?

A

the whole process of sperm development

65
Q

TF: when the mature spermatozoa are released into the lumen, they are motile

A

FALSE

66
Q

when do sperm get the ability to swim?

A

in the epididymis (DHT dependent) with further activation in the female tract

67
Q

volume of ejaculate?

A

1.5-5 ml

68
Q

sperm count per ml

A

40-250 million

69
Q

sperm motility 1h after ejaculation

A

70%

70
Q

sperm motility 3h after ejaculation

A

60%

71
Q

why do we want a low leukocyte count in the ejaculate?

A

reports inflammation

72
Q

why is ejaculate fructose concentration important?

A

key metabolic substrate for sperm motility

73
Q

fructose conc in the ejaculate?

A

15-600mg/100ml

74
Q

epidymis and ductus deferens makes up ___% of the ejaculate

A

5

75
Q

prostatic secretions make up ___% of the ejaculate volume?

A

13-33

76
Q

seminal vesucle secretions make up ___% of the ejaculate volume

A

46-80

77
Q

bulbourethral gland secretion makes up ____% of the ejaculate

A

5

78
Q

what happens in erection

A

erectile tissue [corpus cavernosum and corpus spongiosum] becomes engorged with blood, arterioles dilated as a result of parasympathetic nervous system activity

79
Q

erection is _____ dependent

A

nitric oxide

80
Q

emission and ejaculation are controlled by the ______ nervous system

A

sympathetic

81
Q

pathological causes of erectile dysfunction?

A

psychogenic
neurogenics
vascular
endocrine

82
Q

iatrogenic causes of erectile dysfunction?

A

drugs: SSRis
antihypertensives: BBs Calcium agonist

83
Q

management of erectile dysfunction?

A

PGE1- alprostadil

PDE5 inhibitors: sildenafil

84
Q

how do PDE5 inhibitors work? sildenafil

A

inhibit breakdown of cGMP, maintain erectile function

85
Q

prostate cancer is the ____ cause of cancer death after _____

A

second

lung

86
Q

risk of prostate cancer in men is?

A

1 in 6

87
Q

risk factors of prostate cancer

A

age
ethnicity
family history

88
Q

can prostate cancer be cured? how

consequences

A

yes
surgically
but gives impaired reproductive function

89
Q

symptoms of prostate cancer

A

Urgent and frequent urination
Nocturnal enuresis (involuntary urination)
Difficulty starting or emptying the bladder
Urine flow weak, interrupted or difficult to control
Back or pelvic pain
PSA

90
Q

treatment of prostate cancer depends on?

A

if the cancer is steroid receptor dependent

91
Q

treatment options?

A

GnRH agonists and antagonists
androgen antagonist
5-a-reductase inhibitors

92
Q

how would a GnRH agonist or antagonist work

A

antagonist: will block it all
agonists: high levels make the receptor down regulate

93
Q

androgen antagonist example

what does it depend on?

A

cyproterone acetate

as long as the tumour retains the androgen dependency- can become independent

94
Q

TF: the prostate tumour is always androgen dependent

A

FALSE can become independent

95
Q

examples of 5-a- reductase inhibitors

what does it block

A

Dutasteride
Finasteride
blocks DST

96
Q

TF: prostate cancer is slow growing

A

it can be

97
Q

how can exogenous testosterone be used as contraception?

A

high levels will decrease LH and FSH which will decrease sperm production

98
Q

what is needed to completely inhibit sperm production?

A

VERY high dose exogenous testosterone

99
Q

how does depo-provers plus testosterone provide contraception? what is it?

A

 Combination of progestin with testosterone
 Progesterone gives you negative feedback.
 Exogenous testosterone- maintain circulating testosterone

Patient (19 decks)

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